Objectives : The medical costs generated by senior citizens have been elevated and old users with dementia increased recently. Subjects & Methods : Seventy - one senior patients with dementia received the emergency transportation from our facility. They were 31 males and 40 females, 69-96 average 84.5 years old. Results : Because of serious symptoms and diagnosis, among 71 cases, 43 patients (60.6%) subsequently died, including 12 patients who died on the same day as their emergency transportation. Among these 12 patients, 9 died from cardiopulmonary arrest, 2 died from myocardial infarction, and 1 died from cerebral infarction. The patients ranged in age from 86-96 years, with a mean of 91.8 years. Conclusion : Dementia patients who are over 90 years of age and living in geriatric health services facilities should receive terminal care, rather than emergency care, as these patients have reached the end of their natural life span. Extreme and expensive treatments should only be performed if the patients and their families made such a request at the time of their entrance to the geriatric health services facility.

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In cardiac surgery, one substernal drain and one or two pericardial drain were usually detained. In our institution, we used only one pericardial drain in the case of cardiac surgery. And recently we use only one 19Fr (6.3mm) silicone drain. Because this drain is thin and full of flexibility, patients have little pain and stress. This is advantageous for the patients' rehabilitation. In coronary artery bypass surgery we evaluated utility of this silicone drain. We performed CABG for 139 patients (mean age was 66, 102 men and 37 women) between November 2004 and December 2006. On pump CABG was performed for 106 patients and OPCAB (Off pump coronary bypass grafting) was done for 33 patients.
Mean total volume of drainage was 305ml (on pump CABG was 331ml, OPCAB was 319ml). There were no cases with the drain occlusion, the reopening for bleeding and the perioperative cardiac tamponade. In coronary bypass surgery, the postoperative care in only one pericardial silicone drain (19Fr) did not have any problem.

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The purpose of this study was to describe the implementation and evaluation of an exercise calendar program for community residents to prevent and cope with urinary incontinence. The subjects of the study were 100 residents who attended a presentation on urinary incontinence prevention in "A" city. In the first stage, one-month exercise calendars were distributed to the participants to perform three activities (pelvic floor exercise, fluid intake, and prevention of constipation), and were returned by mail. In the second stage, 3-month exercise calendars for pelvic floor exercise were mailed to the respondents. There were 20 respondents in the first stage, and all the three activities of the one-month program were completed in 61.8±29.8% of the 30 days. Four persons improved their urinary symptoms after the first stage. There were 10 respondents in the second stage, and the three-month program was implemented in 78.7±17.0% of the 90 days. Urinary symptoms were improved in five participants after the second stage. These results suggest that focused objectives and strategies with a limited number of activities are effective for continuation of the urinary incontinence prevention program.

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Background and Purpose : There are not many reports on the hopes of breast cancer patients. The purpose of this study is to clarify the hopes that primary breast cancer patients raising underage children have before discharge and to investigate nursing support for them. Subjects and Methods : The subjects were 10 primary breast cancer patients aged 20-49 years having children under 18 who agreed to participate in the study. Data were collected from semi-structured interviews and nursing records on or after postoperative day 3. Using a qualitative inductive method, patients' words concerning hope were coded, and then the codes were abstracted into categories and subcategories according to similarity. Results : Three hopes, "to be cured", "self-realization" and "growth of themselves and people around them", were revealed as the hopes that primary breast cancer patients raising children under 18 had before discharge. "To be cured" consisted of 2 subcategories, "to devote themselves to treatment" and "health promotion". "Self-realization" consisted of 8 subcategories, "next pregnancy", "work as the meaning of life", "rapport with children", "fulfillment of the mother's role", "to live by their own values", "to live in society", "to live as before" and "to plan their future life". "Growth of themselves and people around them" consisted of 4 subcategories, "growth of children", "growth of the husband", "growth of themselves" and "development of family relationships". Conclusion : Our findings suggested that it is necessary in nursing support for breast cancer patients raising children to teach concrete methods for environmental adjustment and health maintenance, so that patients can first devote themselves to treatment as the first stage to realize their hope to live normal lives as before.

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Objective : An interventional study was performed to examine whether oral exercise as a population approach is effective for improving the ADL, QOL, and oral function of day-care users. Subjects and Methods : Day-care users who could brush their teeth by themselves and answer an interview survey were divided into intervention (n=15) and no-intervention (n=10) groups, and pre- and post-intervention surveys (basic characteristics, ADL, QOL, depression, oral function, state of oral hygiene, etc.) were performed. The intervention group practiced oral exercise for 6 months after the pre-intervention survey. The changes observed after the intervention were compared between the two groups by the t-test (unpaired). Results : No change was observed in ADL. A significant difference was noted in the QOL concerning "speak everyday". Regarding the oral function, significant differences were observed in oral dryness, cheek inflation (bilateral, left), and downward tongue movement. The parameters examined generally tended to improve in the intervention group but to deteriorate in the no intervention group. Conclusion : The results suggest that oral exercise is effective for improving the QOL, oral function.

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The objective of this study was to evaluate outcomes of visiting nursing care for patients with intractable neurological diseases. The subjects of the study were 7 patients with intractable neurological diseases who used home care services from "B" visiting nursing station which was affiliated with "A" specialized hospital for brain/neurology. We measured outcomes of visiting nursing care at baseline and three months using the Japanese version of the Outcome Assessment Information Set and the Schedule of Individual Quality of Life - Direct Weighting (SEIQoL-DW). There were 5 improved cases with maintaining the maximum QOL level, while the same numbers of improved and declined cases were seen in outcomes evaluation by visiting nurses. The QOL was decreased in two cases, while a declining trend was common in the outcomes evaluation. Therefore, visiting nurses need to focus on an improvement trend in patients with gradually progressing intractable neurological diseases, and promote outcomes evaluation.

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A 58-year-old woman suffered from left pyelonephritis with diabetic triopathy on admission at which time a double J stent was inserted in the left ureter and was left untreated for a year. She was admitted due to fever, thirst, polydipsia, polyuria and, left 1,2-toe ulcer and vacuole. We diagnosed diabetic foot infections. We used 6g of ampicillin-sulbactum and 40μg of alprostadil alfadex daily in addition to diet and insulin therapy for diabetes mellitus. As the toe lesion deteriorated, a left foot amputation was performed at the 11^th day. The subfever continued and the consciousness level deteriorated from alert to 100 on the Japan coma scale and acute respiratory failure occurred 21 days after operation. Whole body computed tomography showed invasive lesions in bilateral pulmonary lower lobes and renal pelvic dilatation and perirenal abscess in left kidney indicating renal abscess. Milk-like urine was excreted. Urine and blood culture detected Candida glabrata. Fundoscopic exam showed retinal exudates indicating mycotic endophthalmitis. We diagnosed candida glabrata sepsis from pyelonephritis. After using 200mg of micafungin daily, the patient recovered. In addition to exchanging the stent, treatment of diabetes mellitus is important for the prevention of severe infection.

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A 66 year-old male underwent a distal gastrectomy with D2 dissection in April 2003. Pathological findings showed a well-differentiated carcinoma with a depth of m, n2, stage II. Six months later, a computed tomography revealed multiple lymph node swellings in the para-aortic lesion ; we judged this to be a recurrence of the gastric cancer. As treatment, paclitaxel was administered weekly on days 1, 8, and 15, in combination with doxifluridine for 5 days per week, on a 28-day cycle. Following three courses of chemotherapy, the lymph nodes had almost disappeared. This therapy was continued until January 2007. Because of the appearance of a Virchow lymph node, S-1 + cisplatin was administered. Following administration of the altered chemotherapy regime, a computed tomography displayed a significant reduction in Virchow lymph node swelling. Four years and ten months following the initiation of chemotherapy, the patient displayed jaundice. A computed tomography revealed lymph node swelling in the hepato-duodenal region. Following bile duct drainage, he received four cycles of paclitaxel and doxifluridine therapy. The patient then received S-1 monotherapy for 5 months. He died in February 2010, 6 years and 3 months after the recurrence in the stomach cancer.

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